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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by femlite on November 26, 2003, at 14:53:23
Im about ready to dump my 4th pdoc. Im going to try to be hopeful for one more visit.
I thought we had established I am BP II.
So I am totally clueless as to why hes trying to head me in a Lamictal and/or Lithium alone direction.Am I missing something?
Im currently on WB xl 150 mg, plus now lamictal 25 mg.
I am still cycling and worse than when I sought treatment 4-6 months ago. (my lack of cycling then though was by virtue of the fact that I waS ON pain meds) When I went off the pain meds my mood swings came back.
One prior pdoc called me depressed and put me on WB. It went rather well (excepting SE's) for about 2 months and then the motivation boost wore off.
This pdoc thinks the WB is causing me to cycle,
(a possibilty Im willing to consider) but I was so depressed the week I started the Lamictal I was in bed for three days. (starting a new med is a cause Im willing to consider)I guess the way I see it, out of the four pdocs I been to, none have been great comunicators. (i.e. why Im taking or not taking something, AND LISTENING TO WHAT I THINK ABOUT IT).
Im having signifigant agitation At the moment (which is my mania) so he told me to stop the WB altogether. When I mentioned that I was told by another doc that WB is not primarily activating, but motivational boosting (which Im not getting now anyway) he disagreed and said "Yes it is activting"
Im terrified to stop the WB. I rember what I was like b4 when I would spend half my days in bed due to mental and emotional lethargy and sure dont want to go back.
When I asked if the Lamicatal was the primary direction we'er heading in he said yes.
BIG QUESTION.
Is their a BP here that is functioning on Lamictal and/or Lithium alone?He said we might add Lithium later :-0
I have a friend who is BP II, is on Lithium alone and still suffers from depression (her last pdoc left town and she hasnt been to another in years)
While screaming at my kids over nothing is a nightmare to me, being down and sedated cant be the only alternative, can It?
Posted by femlite on November 26, 2003, at 15:37:43
See LAMICTAL 4 DEPRESSION A FEW THREADS UP BY FEMLITE AND SCROLL HALF WAY DOWN TO "BIG QUESTION FOR THE SHORT VERSION" IF DESIRED
THANK YOU
Posted by Maxime on November 26, 2003, at 21:13:31
In reply to LAMICTAL 4 DEPRESSION? C BIG QUEST 4 short version, posted by femlite on November 26, 2003, at 14:53:23
Maybe you pdoc is trying to see if the anti-depressants are what are causing you to be manic. There is such a thing as a medication induced mania. Many people who are Bipolar are treated with Lithium, or depakote or lamictal etc. WITHOUT an anti-depressant. Just because it didn't work for your friend don't assume it won't work for you. And some use a mood stabiliser alone and when depression becomes a BIG problem is an anti-depressant added.
Anyhow, your pdoc isn't out in left field or anything like that.
Wellbutrin is activating. It can be for some people. I'm bipolar and when I was on it I went psychotic .... that is how manic it made me.
HOWEVER, 25 mg of lamictal is really low and I am assuming your doctor plans to increase that or try another mood stabiliser. Trileptal is SUPPOSE to be good for people who are rapid cyclers and it doesn't cause weight gain.
Maxime
Posted by pixygoth on November 27, 2003, at 5:30:02
In reply to Re: LAMICTAL 4 DEPRESSION? C BIG QUEST 4 short version, posted by Maxime on November 26, 2003, at 21:13:31
hi there -
My doc has just (well *we* have just) decided that I'm probably BPII rather than depressed - I'm irritable as a very irritable thing and sometimes can't sit still for agitated rage, ho ho. Seems to be almost all mixed though, no "cycling" as far as I can see. although my head is minced just now, my memory shot and etc.
Anyway, I have come off Efxr (225mg at peak) and now taking 25mg Lamictal just like you. I take it you're tapering up also like me? In a month I should be at 100mg a day. The slow start is to fend off "£$THE_RASH$£" isn't it? ANyway, apparently here just lith. or whatever stabiliser is quite normal alone. Are you U.S., yes? I'm amazed by the layers of drugs you guys get, I am naturally more trusting of taking one thing at once - I reckon the potential for complicated molecules to interact inside you is too big and scary for me.
Anyway I wanted to tell you this stuff - I'm in the boat with ya, femlite.
Takecare
S
Posted by Flipsactown on November 27, 2003, at 13:19:35
In reply to LAMICTAL 4 DEPRESSION? C BIG QUEST 4 short version, posted by femlite on November 26, 2003, at 14:53:23
Stick with your pdoc. Lamictal has been shown to be very effective not only on bipolar depression, but unipolar(no mania) as well. Also, lamictal is not sedating. I take 300mg of lamictal and in 6 weeks I noticed a dramatic lifting of my unipolar depression. However, I am also taking prozac and remeron in addition to lamictal. The reason your pdoc is starting you out on a low dose of lamictal, is to decrease the chance of your getting a rash which in rare cases can be fatal. It has been 8 weeks since lamictal was first added to prozac and remeron, and I am now depression free. Give your pdoc a chance. He/She is on the right track.
Flipsactown
> Im about ready to dump my 4th pdoc. Im going to try to be hopeful for one more visit.
> I thought we had established I am BP II.
> So I am totally clueless as to why hes trying to head me in a Lamictal and/or Lithium alone direction.
>
> Am I missing something?
>
> Im currently on WB xl 150 mg, plus now lamictal 25 mg.
>
> I am still cycling and worse than when I sought treatment 4-6 months ago. (my lack of cycling then though was by virtue of the fact that I waS ON pain meds) When I went off the pain meds my mood swings came back.
>
> One prior pdoc called me depressed and put me on WB. It went rather well (excepting SE's) for about 2 months and then the motivation boost wore off.
>
> This pdoc thinks the WB is causing me to cycle,
> (a possibilty Im willing to consider) but I was so depressed the week I started the Lamictal I was in bed for three days. (starting a new med is a cause Im willing to consider)
>
> I guess the way I see it, out of the four pdocs I been to, none have been great comunicators. (i.e. why Im taking or not taking something, AND LISTENING TO WHAT I THINK ABOUT IT).
>
> Im having signifigant agitation At the moment (which is my mania) so he told me to stop the WB altogether. When I mentioned that I was told by another doc that WB is not primarily activating, but motivational boosting (which Im not getting now anyway) he disagreed and said "Yes it is activting"
>
> Im terrified to stop the WB. I rember what I was like b4 when I would spend half my days in bed due to mental and emotional lethargy and sure dont want to go back.
> When I asked if the Lamicatal was the primary direction we'er heading in he said yes.
>
>
> BIG QUESTION.
> Is their a BP here that is functioning on Lamictal and/or Lithium alone?
>
> He said we might add Lithium later :-0
>
> I have a friend who is BP II, is on Lithium alone and still suffers from depression (her last pdoc left town and she hasnt been to another in years)
>
> While screaming at my kids over nothing is a nightmare to me, being down and sedated cant be the only alternative, can It?
Posted by Maximus on November 27, 2003, at 19:09:04
In reply to LAMICTAL 4 DEPRESSION? C BIG QUEST 4 short version, posted by femlite on November 26, 2003, at 14:53:23
Hi Femlite,
Actually Lamictal WITH Lithium is the most successful combo for the treatment of the bipolar II disorder. I am told by my psychiatrist that this combo is the Cadillac one. I admit it works nicely for me and many others.
Lithium alone isn't very effective to prevent a depressive episode. And Lamictal alone is often not enough by itself to maintain mania at bay.
In unipolar depression (depression only), the Lamictal is often used with another agent, like an antidepressant, to prevent depression.
Posted by lesliekay on November 30, 2003, at 7:21:18
In reply to LAMICTAL 4 DEPRESSION? C BIG QUEST 4 short version, posted by femlite on November 26, 2003, at 14:53:23
I hope you please read this...I didn't have the time to read your other posts from people because I have to go to work....Lamictal is awesome...it is the only mood stabilizer out there that they actually considered to use as an AD alone. You can not not not not be on an AD without a mood stabilizer. It is the truth that Wellbutrin is the least activating, but I said least. Lamictal worked wonders for me and a lot of my patients, the only thing that sucks is that you have to titrate it very slowly. It is impossible that either med could be giving any results at those low doses and short periods of time...a lot of patience is what you need. Please Please go for it...I have had this for 18 years and Lamictal was one of 4 drugs that gave me anything to speak of. leslie
Posted by theo on November 30, 2003, at 9:48:05
In reply to Re: LAMICTAL 4 DEPRESSION? C BIG QUEST 4 short version, posted by lesliekay on November 30, 2003, at 7:21:18
I'm currently taking 300mg of Wellbutrin XL and thinking about dropping back to 150mg because I haven't noticed any positive benifits from dose increase. I'm also taking 300mg Neurontin at bedtime, which with a six hour half life seems to do nothing as far as carrying me through the day, and I've tried taking it during the day and it does nothing but make me feel uncomfortable. After about 8 weeks I've not noticed any benefits for anxiety or much for depression. I've got a doctors appt. this week and am wondering if Lamictal would be worth a try. My other thought was adding a low dose of Paxil to 150mg Wellbutrin XL but know when I decide to stop it I have the fear of withdrawal to deal with. After all that do you think adding Lamictal with 150mg Wellbutrin XL would be a good combo, or Lamictal by itself?
Posted by lesliekay on December 1, 2003, at 2:22:30
In reply to Re: LAMICTAL 4 DEPRESSION? C BIG QUEST 4 short version » lesliekay, posted by theo on November 30, 2003, at 9:48:05
Go for the Lamictal and ask for another AD. Maybe something like celexa or lexapro at a low dose until your lamictal is fully titrated up. I can't speak highly enough for Lamictal...good luck leslie
Posted by femlite on December 1, 2003, at 10:34:50
In reply to Re: LAMICTAL 4 DEPRESSION? C BIG QUEST 4 short version, posted by lesliekay on November 30, 2003, at 7:21:18
I feel I need to clarify. Im looking at evidence of mono therapies (Lamictal included) that work for BP II. I don’t doubt the efficacy of Lamictal. I know If I’m truly BP, we're not going to get any where with out a mood stabilizer. I think Lithium is also a good option but I would choose Lamictal over Lithium .
The part I’m struggling with is my pdocs lack of communication skills, (dont they teach that in psych school?) and someone telling me to take a psychotropic medicine and not explaining "what the point of this therapy is" is frightening for me.
I don’t think it is wise for me to just drop the WB. So I am trying to titrate down on my own.I also fully aware of the need to titrate Lamicatal up slowly.
What I don’t understand, is given my equal propensity for deep depression,(which dominates the balance of my mood swings) why my pdoc is not discussing with me the future possibility of a different AD.
I hate being treated this way and forgive me, but that’s his problem. My doctor phobia is something he has to be willing to WORK with me on.He’s already indicated that he realizes I am frightened of big changes in my meds. I am also frightened of not knowing where we're headed.
I realize he’s human and may not even be sure. But can’t he at least give me the consideration of respecting my intelligence and participation in a dialogue of those future possibilities.If his reason for not allowing me to be privy to the game plan is based on the "15 minutes for each patient" model of dr/patient relation, than I’m out of here. I can’t deal with that. I think there must be other doctors who operate with more respect for patient’s human failings.
I’m sorry, but this cant be a one-way relationship. I do all the understanding, make all the allowances, take all the cr*p, and keep smiling, "I guess he's the doctor" nonsense".I come home from visits characterized by this antiquated notion ("me all knowing doctor - you passive docile patient") deeply depressed and filled with fear and hoplessness. Is it worth that?
Do we sense I have an issue here? Darn right and I told him that from the start. It seems I didn’t explain it well enough, or he doesn’t get it or he doesn’t care. I m sure there are patients less troublesome than I, from whom he can collect his 50 -75 bucks, go home and the end of the day and not think about.
So be it. It’s his choice.I’m sure Lamictal has a good chance of helping me and if the next Pdoc wants to mess with that, I guess Ill have some serious thinking to do. Each new pdoc almost comepletely changes my meds, which should give us a clue on the "all knowing doctor" model and be a possible basis for they're humilty,dont you think?None them agree on what to do with me. Im thr only unchanging variable and always will be. But how much respect do my views about my heath get?
Thank you Leslie and all, esp. for letting me blow off some steam.
I do want to hear from BP II patients. I don’t believe there are any out there doing well on Lam alone. Mono therapies arent often effective for "most" BPs.
At least that’s what my reading indicates.
If he has a different idea, it’s his responsibility to help me understand that.If any BPs have expereince with mono threrapies that work. Im am very willing to listen. Im not closed minded to evidence, just doctors who insult my intelligence and my humanity.
> I hope you please read this...I didn't have the time to read your other posts from people because I have to go to work....Lamictal is awesome...it is the only mood stabilizer out there that they actually considered to use as an AD alone. You can not not not not be on an AD without a mood stabilizer. It is the truth that Wellbutrin is the least activating, but I said least. Lamictal worked wonders for me and a lot of my patients, the only thing that sucks is that you have to titrate it very slowly. It is impossible that either med could be giving any results at those low doses and short periods of time...a lot of patience is what you need. Please Please go for it...I have had this for 18 years and Lamictal was one of 4 drugs that gave me anything to speak of. leslie
> I hope you please read this...I didn't have the time to read your other posts from people because I have to go to work....Lamictal is awesome...it is the only mood stabilizer out there that they actually considered to use as an AD alone. You can not not not not be on an AD without a mood stabilizer. It is the truth that Wellbutrin is the least activating, but I said least. Lamictal worked wonders for me and a lot of my patients, the only thing that sucks is that you have to titrate it very slowly. It is impossible that either med could be giving any results at those low doses and short periods of time...a lot of patience is what you need. Please Please go for it...I have had this for 18 years and Lamictal was one of 4 drugs that gave me anything to speak of. leslie
Posted by Golf4 on December 1, 2003, at 15:56:10
In reply to Clarification; Lamictal as monotherapy for BP II, posted by femlite on December 1, 2003, at 10:34:50
Hi,femlite
I agree with you 100%!
Your dwelling on this controversial issue is justified moreover that BP2 is one of the most complex maladies, difficult to treat,though possible provided that not only YOU have the patience and the intelligence to deal with it,but your doc.,too….as far as I observe, you do face a problem regarding your actual doc and I strongly suggest you to try and find someone who is intelligent and with a good willing (at least) as you are.
Concerning Lamictal which IS approved already by FDA for prophylactic BP treatment ,seems to be a promising(statistically obtaining quite high marks) med with some quite good mood stabilizing effects and even with some AD effects,too ,BUT certainly(according to my opinion and experiences) having not enough AD qualities to substitute a usual AD (in my case it has been once Celexa and now days Zoloft).
The consensus among 99% of the professionals is that a BP2 one must augment his AD with a Mood Stabilizer=a mania,or hypo mania blocker and one of these “mood stabilizers” is considered (now days already officially) being Lamictal,too
I can just strongly suggest you :DO not to stop taking an AD which works for you(for instance one of the SSRI’s),but rather add a mood stabilizer(as Lamictal,but staying on quite” reasonable” doses which should be between 50-125mg,depending?!...on your doc’s “philosophy”
Do not forget that the biggest difference between a BP1 and a BP2 is that the second has much more frequent and disabling depr.episodes which need a real ANTI depr.drug and not just a drug having “some “ AD qualities,too(like Lamictal)
All the best to you and DO NOT GIVE UP!
==========================================> I feel I need to clarify. Im looking at evidence of mono therapies (Lamictal included) that work for BP II. I don’t doubt the efficacy of Lamictal. I know If I’m truly BP, we're not going to get any where with out a mood stabilizer. I think Lithium is also a good option but I would choose Lamictal over Lithium .
>
> The part I’m struggling with is my pdocs lack of communication skills, (dont they teach that in psych school?) and someone telling me to take a psychotropic medicine and not explaining "what the point of this therapy is" is frightening for me.
> I don’t think it is wise for me to just drop the WB. So I am trying to titrate down on my own.
>
> I also fully aware of the need to titrate Lamicatal up slowly.
>
> What I don’t understand, is given my equal propensity for deep depression,(which dominates the balance of my mood swings) why my pdoc is not discussing with me the future possibility of a different AD.
> I hate being treated this way and forgive me, but that’s his problem. My doctor phobia is something he has to be willing to WORK with me on.
>
> He’s already indicated that he realizes I am frightened of big changes in my meds. I am also frightened of not knowing where we're headed.
> I realize he’s human and may not even be sure. But can’t he at least give me the consideration of respecting my intelligence and participation in a dialogue of those future possibilities.
>
> If his reason for not allowing me to be privy to the game plan is based on the "15 minutes for each patient" model of dr/patient relation, than I’m out of here. I can’t deal with that. I think there must be other doctors who operate with more respect for patient’s human failings.
>
> I’m sorry, but this cant be a one-way relationship. I do all the understanding, make all the allowances, take all the cr*p, and keep smiling, "I guess he's the doctor" nonsense".I come home from visits characterized by this antiquated notion ("me all knowing doctor - you passive docile patient") deeply depressed and filled with fear and hoplessness. Is it worth that?
>
> Do we sense I have an issue here? Darn right and I told him that from the start. It seems I didn’t explain it well enough, or he doesn’t get it or he doesn’t care. I m sure there are patients less troublesome than I, from whom he can collect his 50 -75 bucks, go home and the end of the day and not think about.
> So be it. It’s his choice.
>
> I’m sure Lamictal has a good chance of helping me and if the next Pdoc wants to mess with that, I guess Ill have some serious thinking to do. Each new pdoc almost comepletely changes my meds, which should give us a clue on the "all knowing doctor" model and be a possible basis for they're humilty,dont you think?None them agree on what to do with me. Im thr only unchanging variable and always will be. But how much respect do my views about my heath get?
>
> Thank you Leslie and all, esp. for letting me blow off some steam.
>
> I do want to hear from BP II patients. I don’t believe there are any out there doing well on Lam alone. Mono therapies arent often effective for "most" BPs.
> At least that’s what my reading indicates.
> If he has a different idea, it’s his responsibility to help me understand that.
>
> If any BPs have expereince with mono threrapies that work. Im am very willing to listen. Im not closed minded to evidence, just doctors who insult my intelligence and my humanity.
>
Posted by lesliekay on December 2, 2003, at 3:20:31
In reply to Clarification; Lamictal as monotherapy for BP II, posted by femlite on December 1, 2003, at 10:34:50
I hate to be crass but I can only think of one word...your doc is a jerk. It is so hard to find a doc that is worth your time, effort, and money. Oh, just so you know, I am a rapid cycling bp2. My meds are a lot.....Abilify,Topamax, Klonopin, Celexa, Provigil, Cogentin, Ativan and for the first time in 18 years, all is well!!!! I love and adore my doc because he lets me do just about anything as long as it is safe....I hope the same for you in the near future....leslie
This is the end of the thread.
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